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This section discusses the constructs in the tool and provides the rationales to include them. As shown inFigure 2, the tool consists of the four elements of PACAP and RACAP (acquisition, assimilation,

transformation and exploitation), linking relevant antecedents (organised into three categories: socialisation capability, system capability and co-ordination capability) with a number of commissioning outcomes of ACAP following QIPP (including commissioning-related criteria such as the perceived quality of the commissioning, as well as organisational outcomes such as innovation, productivity and prevention). Most of the variables are assessed with respect to one particular exemplary commissioning process, which is hereafter referred to as the commissioning of Project X, whereas the remaining variables are about the CCG in general.

In the following section we provide a brief explanation for each group of variables. An extensive description of the development of all variables, including their theoretical and empirical origins, can be found inAppendix 1.Table 4summarises the variables and items of the tool.

Antecedents of absorptive capacity

Socialisation capability

Socialisation capability refers to an organisation’s vision to produce a shared ideology and develop of a distinct group identity, and focus on the connectedness of different professionals.13,141_{A shared ideology}

is achieved through‘congruence of values, needs, and beliefs among individuals within units’, whereas connectedness of different staff groups encouraged trust and communication, as well as knowledge sharing in the organisation.8_{We view socialisation capabilities as a cornerstone for ACAP, laying the psychological}

and social foundation for individuals to constructively interact and share information with each other. We therefore capture a range of concepts, including attitudes towards colleagues and the CCG (trust in colleagues and in CCG managers, and trust between a CCG and its partners; affective commitment towards the CCG; and identification with the CCG), emotional responses as vital indicators of the experience of the functioning of the commissioning process, and individual and team behaviours directly underlying ACAP (knowledge sharing, group knowledge sharing, team reflexivity, taking charge, voice, being heard and group influence). SeeTable 4for a summary.

System capability

System capability refers to the existence and making use of knowledge-sharing platforms such as organisational and team infrastructures and formal knowledge exchange mechanisms including written policies, procedures and manuals that are explicitly designed to facilitate the transfer of codified knowledge.4,8,11_{We assess the}

existence and use of organisational and team infrastructure, the existence and use of rules and procedures and the CCGs feedback-seeking behaviours (seeTable 4).

Socialisation capabilities Knowledge sharing Trust Commitment/identification Team reflexivity Emotion Taking charge Voice/being heard Influence System capabilities

Rules and procedures Feedback seeking Knowledge-sharing platform Organisation/team infrastructure Co-ordination capabilities Cross-functional interaction Participative leadership ACAP Acquisition Assimilation Transformation Exploitation Outcomes of commissioning Innovativeness of CCG Quality of decision Use of resources Acceptability of the outcome

FIGURE 2 Overview of the framework.

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TABLE 4 Constructs and sources

Concepts Constructs Items Sources

Socialisation capability

Individual knowledge sharing

1. I was kept informed of what my CCG colleagues knew about Commissioning Project X

2. When I needed certain information about Commissioning Project X, I asked my CCG colleagues

3. I informed my CCG colleagues of what I was working on, related to Commissioning Project X 4. When I learnt something new related to

Commissioning Project X, I made sure my CCG colleagues learnt about it too

van den Hooff and Huysman126

(2009)

Group knowledge sharing

1. CCG colleagues shared relevant information or knowledge with one another

2. If a colleague in the CCG had some relevant information or knowledge, he or she was not likely to tell the others about it

3. CCG colleagues provided each other with hard-to-find relevant information or knowledge

Faraj and Sproull127

(2000)

Trust (in CCG colleagues)

1. They helped me if I had difficulties with my CCG-related job

2. They took my interests into account 3. They kept me informed

4. They kept their word

5. They had the best interest of service users at heart 6. They had the best interest of their own practice/

organisation at heart

7. They had the best interest of their professional group at heart de Jong and Elfring128 (2010) Trust between CCG and partners

1. The relationship with this partner was mutually trusting

2. This partner kept its promises to our CCG 3. Our CCG was sure that what this partner said

was true

Poppoet al.129

(2008)

Trust in CCG managers

1. I wish I had more influence over the manager’s decision

2. I share my opinion about sensitive issues with the manager even if my opinion may be unpopular 3. If the CCG manager asks why a problem

happened, I speak freely even if I am partly to blame

4. My manager and I have mutual trust

Mayer and Gavin130

(2005)

Organisational commitment

1. I do not feel a strong sense of belonging to my CCG

2. I do not feel personally attached to my CCG 3. Working at my CCG has a great deal of personal

meaning to me

4. I really feel that problems faced by my CCG are also my problems

Conwayet al.131

(2014)

Identification 1. When someone criticises the CCG, it feels like a personal insult

2. I am very interested in what others think about my CCG

3. When I talk about this CCG, I usually say‘we’ rather than‘they’

4. When someone praises the CCG, it feels like a personal compliment

Mael and Ashforth132

(1992)

TABLE 4 Constructs and sources (continued)

Concepts Constructs Items Sources

Team reflexivity 1. The CCG reviewed the feasibility of our objectives 2. The CCG discussed the methods used to get the

job done

3. The CCG discussed whether we were working effectively together

4. The CCG modified our objectives in light of changing circumstances

5. The CCG reviewed our approach to getting the job done

de Jong and Elfring128₍₂₀₁₀₎

Emotion Angry, frustrated, disappointed, anxious, fed up, let down, happy, surprised, excited, proud, satisfied, pleased

Van Katwyk

et al.133

(2000) Taking charge 1. I tried to bring about improved procedures

2. I tried to correct a faulty procedure or practice 3. I tried to eliminate redundant or unnecessary

procedures

4. I tried to change rules, procedures and policies that were non-productive or counterproductive

Morrison and Phelps134₍₁₉₉₉₎

Voice 1. I spoke up with ideas for changes in work procedures of the CCG

2. I communicated opinions about CCG-related work issues to others even if my opinions differed or others disagreed

3. I developed and made recommendations on CCG-related work issues

Van Dyne and LePine135

(1998)

Being heard 1. My voice was heard by the CCG general manager 2. My voice had influence over commissioning

decision

3. My voice should have had more influence

New scale

Influence Managers, doctors, nurses, local authority, PPI New scale System capability Rules, procedures

and knowledge- sharing platform

1. I used the IT system in place

2. I actively participated in meetings where end service users were involved

3. I actively participated in public and community events

Feedback seeking 1. The CCG checked how satisfied partners were with the commissioning process

2. The CCG asked for feedback from internal and external customers on the result

3. The CCG checked how well we performed as a team

Schipperset al.136

(2007)

Organisational and team infrastructure

1. An efficient IT system is in place to help our decision-making

2. We involve end-users to inform our decision-making

3. I am required to attend meetings/events where end-users are involved

4. Community and other public sector events are held to help with our decision-making

5. I am required to attend community and other public sector events

New scale

Co-ordination capability

Cross-functional interaction

1. I know the functions of other colleagues in my CCG 2. People in my CCG know each other’s job/function 3. I regularly have interactions with other colleagues

in my CCG

4. People in my CCG regularly have interactions with each other

5. We hardly ever meet other colleagues in my CCG

New scale

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TABLE 4 Constructs and sources (continued)

Concepts Constructs Items Sources

Participative leadership

1. The CCG general manager encouraged us to express ideas/suggestions

2. The CCG general manager listened to our ideas and suggestions

3. The CCG general manager used our suggestions to make decisions

4. The CCG general manager gave us a chance to voice our opinions

5. The CCG general manager considered our ideas when he/she disagreed with them

6. The CCG general manager made decisions that were based only on his/her own ideas

Arnoldet al.137

(2000)

ACAP Acquisition 1. I searched for relevant information

2. I acquired relevant information

3. I used the standardised national statistics for information

4. I identified gaps in existing information

Flattenet al.138

(2011)

Assimilation 1. I communicated ideas across the CCG

2. I appreciated support from other colleagues in the CCG to solve problems

3. I communicated knowledge I obtained promptly to all other colleagues in the CCG

4. I met other colleagues in the CCG periodically to interchange new developments, problems and achievements

Transformation 1. I used collected information

2. I prepared new knowledge for future use 3. I linked existing knowledge with new insights 4. I applied new knowledge in my practical work Exploitation 1. I supported the development of new practice/

technologies in the CCG

2. I incorporated feedback in my CCG work 3. When a new idea met resistance within the CCG,

I put in a great deal of effort to guarantee the idea was brought to fruition

Outcome of commissioning

Innovativeness of CCGs

1. The CCG adopted new way of doing things from other CCGs

2. The CCG tried new ways of doing things and sought unusual, novel solutions

3. The CCG encouraged people to think and behave in original and novel ways

Wang139

(2008)

Quality of decisions 1. The decision of what services were needed 2. Ensuring needed services were provided 3. Comparing to other CCGs that you are

familiar with 4. Use of resources 5. Ability to meet objectives

Bresman140₍₂₀₁₀₎

Acceptability of the outcome

Considering the resources available, how acceptable was the outcome of the commissioning of Project X?

Added with suggestions from PPI group

Co-ordination capability

Co-ordination capability refers to‘knowledge exchange across disciplinary and hierarchical boundaries’and normally includes job rotation and cross-functional interaction and participation in decision-making.8_Job

rotation is not identified as a characteristic of CCGs from the qualitative study and hence was excluded from the tool. However, cross-functional interaction and leadership were identified as important functions of co-ordination capability in the interviews. We capture interactions across knowledge and hierarchical boundaries as well as the extent and quality of participative leadership from both the individuals’and managers’perspectives.

Absorptive capacity

As outlined inChapter 2, Absorptive capacity, we adopt Zahra and George’s13_{conceptual framework}

of ACAP, which characterises four activities: (1) identifying and accessing relevant knowledge through

acquisitionprocesses; (2) analysing and interpreting this knowledge throughassimilation; (3) integrating existing knowledge with the newly assimilated knowledge throughtransformation; and (4) refining and developing existing organisational routines and behaviours throughexploitationof the transformed knowledge.

The scale items of ACAP are adapted from Flattenet al.138_{Comparing across different existing ACAP}

scales,142–144_{the one developed by Flattenet al.fits with the CCG context most closely.}138_However,

Flattenet al.138_{focus on collective ACAP. In this study, we adapt the items to assess individual ACAP.}

The rationale to assess individual ACAP is twofold. First, our qualitative study suggests that people working in CCGs might not be familiar with each other’s work, and, therefore, collective-level ACAP might not capture a full picture. Second, individual ACAP is in line with other individual-level constructs measured in this study. The scales for each element of ACAP were adjusted accordingly.

Outcomes of absorptive capacity

This element of the tool aims to understand how ACAP and its antecedents relate to a range of outcomes, both related to the end result of the commissioning process as well as wider outcomes for the CCG. We based the outcomes of ACAP on the QIPP model proposed by the UK Department of Health and Social Care. We adapt the QIPP model and assess innovativeness of CCGs and the quality and productivity of commissioning to fit the CCG context.

Methods

The development of the tool started after the qualitative part of the study finished and all executive reports were submitted. We developed the tool in three iterative steps in collaboration with PPI. The fourth step of the tool development, the rigorous psychometric testing of it, lies outside the scope of this bid and is currently under way.

1. Development of the theoretically guided model, including antecedents, ACAP and consequences, based on previous theory and research as well as the results of the qualitative study (in close collaboration with PPI).

2. Operationalisation of all three elements of the model (antecedents, ACAP and consequences). We developed items following our theoretical assumptions and by drawing heavily on existing measures, amending and extending those based on the results from the qualitative data.

3. Revising and editing items based on feedback from members of PPI, members of a CCG, academic experts and conferences. The tool was refined with comments from the PPI group and conferences attended, before sending out for piloting in one participating CCG. The role and involvement of the PPI is described in depth inChapter 10.

4. Psychometric testing (outside the scope of this project): we are recruiting CCGs for participation to collect sufficient data to rigorously test the psychometric properties of the tool and to amend where appropriate.

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The final version of the self-development tool consists of an online survey, which takes≈15 minutes to complete. The survey should be self-explanatory and the first page explains what the survey is about and how to complete it. It also asks for respondents’consent, guaranteeing confidentiality. Ethics approval to pilot the tool and to gather data in the future was sought and granted by the University of Warwick and the Biomedical & Scientific Research Ethics Committee.

During the period of development, we presented the tool in several conferences for feedback and to advocate its future dissemination. The conferences and events included Commissioning LIVE London (2 March 2017, London), Improving the Capabilities of NHS Organisations to Use Evidence Workshop (2 May 2017, Warwick) and Health Service Research UK (6/7 July 2017, Nottingham). As a result, we were in conversation with a number of CCGs about the tool and advocated the publicity of the tool. We have also been in conversation with NHS England about the potential dissemination of the tool.

We have also been in contact with CCGs for pilot sites, raising the awareness of the tool. All CCGs that we approached were sent an information sheet (seeAppendix 2) and consent form (seeAppendix 3), introducing the tool and guaranteeing the confidentiality of participants. Participants and CCG anonymity will be maintained at all times during the dissemination of the research findings.

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